inside this issue...ethically, integrity is regarded as the hon-esty and truthfulness or accuracy of...

Inside This IssueInside This Issue Donovanosis Infection Watch

Vitamin D Deficiency: An Epidemic

How Important is Integrity in the Workplace?

An Unexpected Cause of a Bloodstream Infection

AMT Directory

January 2019Volume 21 Number 1

Contents 2 Article 458 Donovanosis Infection Watch By Lisa Maness

7 Questions for Article 458

8 Cases in Clinical Microbiology

10 Article 459 Vitamin D Deficiency: An Epidemic By Deborah Janeczko


18 Article 460 How Important is Integrity in the Workplace? By Alice Macomber


24 Article 461 An Unexpected Cause of a Bloodstream Infection By Ariela Topper, Martina Beckman, Dr. Eleanor A. Powell,

and Dr. Joel E. Mortensen


30 AMT Directory

Journal of Continuing Education Topics & Issues (ISSN 1522-8606) is published in January, April, and August under the sponsorship of the American Medical Technologists, 10700 W. Higgins Rd., Suite 150, Rosemont, Illinois 60018. Copyright 2019 by American Medical Technologists. Subscriptions include three issues of Journal of CE Topics & Issues and three issues of AMT Events: $50.00/year + $10 postage for foreign countries. Members may not deduct subscription price from dues.Postmaster: Please send change of address to AMT, 10700 W. Higgins Rd., Suite 150, Rosemont, Illinois 60018.Moving? Be sure AMT publications move with you. Send your new address and old mailing label from an AMT publication to AMT six weeks before you move.

On the cover: Illustration of a flu virus

Associate EditorJanet Rosenberg

Business OfficeAmerican Medical Technologists10700 W. Higgins Rd., Suite 150Rosemont, IL 60018847-823-5169e-mail address: [email protected] Site: http://www.americanmedtech.org

January 2019Volume 21 Number 1

Journal of Continuing Education Topics & Issues January 2019 | 1

Donovanosis is a disease caused by Klebsi-ella granulomatis, the genus of which was changed from Calymmatobacterium in 1999 following nucleic acid studies. Although it was first described in 1882, donovanosis has been rare outside of developing countries. However, since a woman contracted it in the United Kingdom in 2017, it has appeared in recent news articles in the United States. The ques-tion has become whether this is something people in the U.S. and other industrialized countries need to worry about.

Along with other journals publishing the same story, a Newsweek article issued a head-line in August of 2018 describing a sexually transmitted disease that can cause genitals to become deformed and rot away. The article re-ported that a young woman between the ages of 15 and 24 was recently diagnosed with a flesh-eating sexually transmitted disease in Stockport, England. This article shed light on a sexually transmitted disease that has been heard of by very few outside endemic areas, which include India, New Guinea, Central Australia, Southern Africa and the Caribbean. The problem has never been common in the United Kingdom or in the United States.

For those who suffer from it, symptoms usually appear after an average of 50 days from exposure, with a range between 1 and 360 days having been reported. The disease begins with papules on the skin or nodes under the skin with uneven borders and in-flammation. The area may then enlarge and become circular, which may then ulcerate and bleed easily. Multiple blisters may be seen, with sores often located in the folds of skin; a foul odor is sometimes present.

In men, the specific location may be the balanopreputial region, as well as the sulcus coronal area and the anus.6 It has been noted that the disease is more common in uncircum-cised males or those without access to good hygiene. Women generally experience wounds in vaginal furcula and the labia minor. In addi-tion, extragenital ulcers may occur in both sexes, such as on the nose, lips, larynx and scalp. Organ dissemination has also been re-ported. In endemic regions, extragenital cases have been reported in the spleen, intestines, uterus, abdominal cavity and lungs. Patients with these areas affected may experience fever, anemia, night sweats and weight loss.

History and Individual Cases

of Donovanosis

While donovanosis was first described in the 1880s, the largest reported outbreak was in Dutch South New Guinea between 1922 and 1952, when about 10,000 Marind-anim people contracted the disease. It was reported that sexual practices intensified in this area due to the arrival of outsiders to the area. In addition, promiscuous sexual activity was encouraged by the local religion and semen was used as a healing medicine in the early 1900s. These two activities probably led to the spread of the dis-ease in this region.

In Durban, South Africa, in the late 1980s, an epidemic began that lasted a decade. The primary sexually transmitted infection clinic reported that 3,153 people were affected. During this time period, 11 percent and 16 percent for men and women, respectively, of all ulcers in this region were found to have Donovan bodies. After this epidemic ended,

Article 458

1 Clock Hour

Lisa Maness, PhD, MT(ASCP, AMT), Clinical Laboratory Science Dept., Winston-Salem State University, Winston-Salem, NC

Donovanosis Infection Watch

By Lisa Maness

2 | Journal of Continuing Education Topics & Issues January 2019

It is estimated that 75 percent of adults in the United States have a low vitamin D level. Since levels are not well monitored, this could be even higher. Vitamin D deficiency is a grow-ing disorder that can be treated and prevented. This article will explain the importance of maintaining normal vitamin D levels, causes of deficiency, testing blood levels and treat-ment choices.

Vitamin D is a fat-soluble vitamin, so the body stores excess amounts of it, whereas excess levels of water-soluble vitamins are eliminated. This is important since vitamin D promotes calcium absorption and enables bone growth. Additionally, it helps with cell growth and encoding, and functions as part of the body’s immune system while assisting in neuromuscular function. Additionally, vitamin D reduces inflammation.

Blood Tests

Reasons for testing vitamin D blood levels include screening to rule out a deficiency, monitoring the treatment of someone with a deficiency, and overseeing hypercalcemia and renal failure. There are several lab tests used to test and monitor vitamin D levels: serum concentration of 25(OH)D, circulating 1,25 (OH)D, and 25-hydroxy vitamin D2 and D3 assay tests.

The preferred test for initial screening of vitamin D deficiency is the 25-Hydroxy (0080379). It is also the best indicator of vita-min D status and the chosen test to monitor treatment response. The serum concentration of 25(OH)D is a quantitative chemilumines-cent immunoassay useful in testing for

combined vitamin D2 and D3. The 25-Dihy-droxy (0080285) test is also a quantitative chemiluminescent immunoassay useful in evaluating calcium metabolism in individuals with hypercalcemia or renal failure. It is less appropriate for diagnosing vitamin D defi-ciency, as it indicates the deficiency only when the insufficiency is severe. The 25-Hydroxy-vitamin D2 and D3 serum test (20002348), by Tandem Mass Spectrometry, is an antibody and quantitative liquid chromatography-based test used when there is no response to treat-ment and looks for underlying causes. This test is not the best practice for initial evalua-tion of vitamin D deficiency.

Remember, vitamin D promotes calcium absorption and affects the renal system. Therefore, related testing is often performed when a deficiency is noted. These include parathyroid hormone intact with calcium, used to diagnose calcium disorders resulting from parathyroid dysfunction; parathyroid hormone-related peptide (PTHrP) by LC-MS/MS plasma to aid in diagnosis and monitoring hypercalcemia; and renal function panel, used to screen kidney function for renal failure in individuals at risk for vitamin D deficiency.

Causes

To prevent vitamin D deficiency, it is import-ant to be aware of the causes. The number one cause of vitamin D deficiency is lack of sun exposure. Due to concerns about skin cancer and the desire to remain youthful-looking, many people have avoided being in the sun. And, when they do venture out, they slather themselves with sunscreen and wear

Deborah Janeczko, RMA(AMT), M.Ed.

Vitamin D Deficiency: An Epidemic

By Deborah Janeczko

Article 459

1 Clock Hour


The dictionary gives a simple definition of integrity: the quality of being honest and hav-ing strong moral principles that you refuse to change.1 Integrity is moral uprightness. It is a personal choice to hold one’s self to consistent standards.2 How important is integrity in the workplace? This may not be a subject that you give much thought in your daily life. The intention of this article is to trigger you to think about integrity and what it means to you in the workplace.

Ethically, integrity is regarded as the hon-esty and truthfulness or accuracy of one’s actions. It stands in opposition to hypocrisy. Judging with the standards of integrity in-volves regarding internal consistency as a virtue. As such, one may judge that others “have integrity” to the extent that they act according to the values, beliefs and principles they claim to hold.

Honesty is the cornerstone of integrity. Hon-esty is much more than telling the truth; it is demonstrated in our communication and our actions. We often do not say what we really think in order to keep the peace. Agreeing with something that is against your moral values is not honesty. Being honest in your communication can be done in a professional manner. Saying “With all due respect, I do not agree with your solution and I would be will-ing to discuss it further,” demonstrates your

true feelings when there could be major controversy. When honesty is required in meetings, committees or official capacity, your honest communication often helps con-firm your values. Often people “cave” on important issues to avoid conflict and harbor resentment later.

Over the course of an eight- or 12-hour work-day, there are numerous ways to demonstrate honesty. How does your employer evaluate your integrity? How do your coworkers see you? We all can demonstrate our integrity daily in our work life and our personal lives.

In the medical field, honesty can make the difference in the outcome of a patient’s treat-ment. As a laboratory technician, your work is detailed and requires many steps with checks and balances along the way. Did you follow every step? Did you follow protocol every step of the way? As a medical assistant, did you complete the long medication list? Did you record every vital sign correctly? Did you do anything and everything that you promised the patient you would do?

Some simple ways to demonstrate your integrity are:

Be on time — all the time.

Always tell the truth. “White lies” are lies and lead to habitual dishonesty.3 There are better ways to avoid hurting others.

Alice Macomber RN, RMA(AMT), RPT(AMT), AHI, retired Medical Assisting Instructor at Keiser University, Fort Pierce, FL

How Important is Integrity in the Workplace?

By Alice Macomber

Article 460

0.5 Clock Hour


Case Thirty-Three: An Unexpected Cause of a Bloodstream Infection

By Ariela Topper, Martina Beckman, Dr. Eleanor A. Powell, and Dr. Joel E. Mortensen

Article 461 1 Clock Hour

Ariela Topper, MT(ASCP), and Martina Beckman, MT(ASCP), MHA, are technologists in the Diagnostic Infectious Diseases Testing Laboratory, Eleanor Powell, PhD, is a visiting Scientist in the Diagnostic Infectious Diseases Testing Laboratory, Joel Mortensen, PhD, is the Director of the Diagnostic Infectious Diseases Testing Laboratory, Department of Pathology and Laboratory Medicine, Cincinnati Children’s Hospital

Case Discussion

MALDI-ToF MS (Vitek MS, bioMérieux, Leone, France) identified the organism as Paenibacillus glucanolyticus with 99 percent confidence, but the identification was part of the unclaimed database. Sequencing of the 16S ribosomal RNA gene confirmed the isolate identification as Paenibacillus glucanolyticus, with 99.57 percent sequence homology to a reference sequence.

Once Paenibacillus was identified, the pa-tient’s central line was removed, and antimi-crobial therapy was adjusted based on the isolate’s susceptibility (Table 2).

Antimicrobial susceptibility testing was per-formed using the E-test method (bioMérieux, Leone, France) with blood Mueller Hinton agar at 35°C for 24 hours (Figure 2).

Taxonomy

Until 1993, Paenibacillus spp. were classi-fied under group 3 of the Bacillus family with closest relation to Bacillus subtilis due to similarities in structure and function of flagel-lar genes. Recently, variation found in 16S

Figure 2. Antimicrobial susceptibility testing on blood Mueller Hinton agar

Table 2. Antimicrobial Minimum Inhibitory Concentration by E-test

AntimicrobialAgent

PatientMIC (μg/mL)

CLSI Breakpoints

S R

Ciprofloxin 0.19 <1 >4

Clindamycin >256 <0.5 >4

Penicillin >32 <0.12 >0.25

Meropenem 2 <4 >16

Vancomycin 1.5 <4

Gentamycin 1.0 <4 >16

EDITOR’S NOTE: BEFORE reading the Case Follow-up and Discussion below, study the Case Descrip-tion on page 8 of this issue, and formulate your own answers to the questions posed.


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